DIABETES & PREGNANCY

KEY POINTS

  • If you maintain healthy blood glucose levels before and during your pregnancy, you have the same chance of delivering a healthy baby as all other women
  • High blood glucose levels around the time your baby is conceived can harm your baby
  • For this reason it is important to plan your pregnancy and get help and advice from your specialist diabetes service before becoming pregnant
  • Diabetes tablets are not safe to use before or during your pregnancy. It may be safest to transfer onto insulin before and during the pregnancy
  • You will need to maintain very close contact with your closest specialist diabetes service during your pregnancy, as pregnancy alters your diabetes during the time you are carrying your baby

 

Having a baby is a very important time in your life. It involves going through many changes as you and your body prepare for the coming baby. Managing your diabetes can be quite demanding during pregnancy while there is so much else going on. But it is very important for both you and your baby that you put extra effort into your diabetes at this time.

 

BEFORE PREGNANCY
 

Planning your pregnancy

If your blood glucose levels are high at the time of conceiving your baby, and during the early weeks of pregnancy, your baby is at greater risk of developing abnormalities.

For this reason it is very important to plan your pregnancy where possible. If your pregnancy is planned you can work towards having as healthy-as-possible blood glucose levels during this time.

 

If you are not planning to become pregnant make doubly sure you are using a safe form of contraception. Many of the contraceptive pills are safe for women with diabetes. Intra Uterine Devices (IUDs) may carry an increased risk of infection for some women with diabetes. However, most doctors consider them to be safe. See your GP, family planning doctor or diabetes specialist to arrange contraception.

 

If you know you have had unprotected sex, at a time when you are not planning to become pregnant it is best to visit your doctor as soon as possible afterwards for help and advice.

Once you have decided to become pregnant, visit your nearest specialist diabetes service for pre-pregnancy support and advice. It is best to plan this visit at least three months before you intend to start trying to conceive.

 

Diabetes medications

Most diabetes services will advise you to stop your diabetes tablets before conceiving. This is because it is not known whether diabetes tablets can harm unborn babies. If your blood glucose levels are high once you are off your tablets, you will need to start on insulin for the pre-pregnancy and pregnancy period. You will get a lot of support and teaching from the diabetes service to help you do this.

 

Insulin is much safer than diabetes tablets to take during pregnancy because it is a natural body hormone that we all have. Therefore it does not put your baby at risk.

 

Blood glucose levels

During pre-pregnancy it is best if you maintain your blood glucose levels as near to the normal range (that of people without diabetes) as possible. It’s best if your blood glucose levels are mostly between 4 – 8mml and your HBA1c less than 55 mmol/mol. You and your baby have the best chance of being healthy if you have these levels for three months before conception.

 

Retinal check

Before pregnancy you should get your retinas checked, preferably by an ophthalmologist. Pregnancy can cause retinopathy (diabetes eye damage) to get worse. If you have retinopathy it should be stabilised before you become pregnant.

 

Folic acid

Folic acid is thought to reduce the risk of you having a child with spina bifida or other abnormalities. You should take a 5mg daily folic acid supplement for four weeks before becoming pregnant and also for the first 12 weeks of pregnancy.

 

Alcohol

It is now considered that there is no safe level of alcohol during pregnancy. It is best to avoid alcohol altogether during any time when you may become pregnant, as well as for the duration of your pregnancy. Drinking alcohol during pregnancy can cause your baby to have a condition called ‘foetal alcohol syndrome’. This can result in them having severe behavioural problems throughout life.

 

Smoking

If you smoke, you must try to stop  before conceiving your child. All women who smoke are at more risk of developing problems during their pregnancy. Their babies are also at risk of being too small, premature or malnourished. If you have diabetes and smoke the risks to yourself and your baby are increased.

 

HOW CAN DIABETES AFFECT MY BODY?

If your blood glucose levels are high around the time of conception and early pregnancy your baby has a higher risk of:

  • Developing abnormalities to their heart, spine and kidneys

 

If your blood glucose levels are high during later pregnancy your baby has more chance of:

  • Becoming very large. This can cause problems during delivery
  • Becoming very small
  • Being still born
  • Developing very low blood glucose levels immediately following birth

 

WHAT CAN HAPPEN TO ME AND MY DIABETES DURING PREGNANCY?

Having diabetes increases your chances of:

  • Developing high blood pressure (HOP or toxaemia)
  • If you have existing eye damage (retinopathy) this may get worse
  • Your bodies need for insulin will change and almost certainly increase throughout the pregnancy

 

DURING PREGNANCY

You will be cared for by a specialist diabetes and obstetrics team during your pregnancy. The team is likely to include a diabetes specialist, an obstetrician, a midwife or specialist diabetes midwife, a dietitian and a diabetes nurse educator.

 

You’ll visit your team fortnightly to weekly, depending how things are progressing.

 

BLOOD GLUCOSE TESTING

You will need to test your blood glucose levels very often during your pregnancy. Most people test between 4 – 8 times a day during pregnancy.

The target range set for your blood glucose levels during this time are likely to be lower than your targets before pregnancy. This is because women without diabetes tend to have slightly lower blood glucose levels during pregnancy than at other times. The aim of blood glucose management for those with diabetes in pregnancy is to get as close to this as possible.

 

You should also be alert to the increased risk of having more frequent low blood glucose levels (hypoglycaemia or ‘hypo’). The risk of ‘hypos’ inevitably increases when you are achieving lower blood glucose levels overall, and if left untreated, ‘hypos’ can cause you to pass out.

 

LABORATORY TESTS

It is good to get frequent laboratory blood glucose and HBA1c levels during pregnancy. These are to back up the results you are getting on your own blood glucose meter. Some diabetes services like you to have fructosamine tests as well. These look back over your average blood glucose levels for the past 2-3 weeks.

 

TAKING INSULIN

You will have back up and support from the diabetes midwife or diabetes nurse educator and the dietitian to help you learn the skills you need to be on insulin. They will also give you advice on your insulin doses.

These skills will involve:

  • Eating regular meals and snacks containing carbohydrate food
  • How to inject and store insulin
  • How to avoid your blood glucose level going low (‘hypo’)
  • How to recognise and treat a low blood glucose level

 

SCANS

Scans are a good way of checking on the babies growth and development. They can also pick up on any problems developing. You are likely to have fairly frequent scans during your pregnancy.

 

DURING LABOUR AND DELIVERY

The aim with labour and delivery is to have a normal labour and vaginal delivery if possible. However, because you have diabetes, your medical team will be keen to avoid any problems developing during delivery for either you or the baby.

 

Women with diabetes have a higher chance of needing a caesarean section than women without diabetes. Also labour may need to be induced if your baby is becoming large or your pregnancy is going over term (beyond 40 weeks).

 

You will almost certainly need to go onto an I.V. drip during labour. The drip will have one bottle containing glucose and another bottle containing insulin. The rates of these drips will be changed according to your blood glucose levels. Your blood glucose levels will be checked at least every hour.

 

WHEN BABY IS BORN

Once your baby is born you will come off the I.V. drip. You should be able to start eating fairly soon after delivery. Your blood glucose levels will be checked often. If they go up you will need either diabetes tablets or insulin. Insulin is safest to take if you are breast feeding. However, once you stop breast feeding you can consider diabetes tablets again.

 

Your baby’s blood glucose will be checked often in the first few days following birth. If your blood glucose levels were high during pregnancy, your baby might have been making a lot of its own insulin in order to process the glucose it was getting from you. Once this supply of glucose is cut off (when the placenta separates) the baby is at risk of going low as it might temporarily have too much insulin. This is easily treated when it is picked up and is only temporary.

 

Once you go home it is important to stay in touch with the diabetes team until your blood glucose levels are healthy and you are settled on the medication you are taking for your diabetes.